目的 比较后路短节段经伤椎置钉术中采用悬臂梁复位法与反弓折顶复位法对Denis B型胸腰段骨折伤椎高度恢复的差异.方法 2017年1月—2019年6月,廊坊市第四人民医院和霸州市第三医院采用后路短节段经伤椎置钉治疗Denis B型胸腰段骨折(T11～L2)患者43例,其中术中应用悬臂梁复位法20例(A组),应用反弓折顶复位法23例(B组).观察并记录2组患者术中出血量,术后切口愈合和感染情况及内固定相关并发症发生情况.测量并计算术前和术后3 d伤椎前缘、中部、后缘压缩率和Cobb角,评价伤椎复位情况.采用美国脊髓损伤协会(ASIA)分级评价患者神经功能恢复情况.结果 所有手术顺利完成.所有患者随访6～18个月,平均10个月.A组术中出血量少于B组,差异有统计学意义(P<0.05).A组术后Cobb角、伤椎前缘和后缘压缩率均小于B组,差异均有统计学意义(P<0.05).A组2例和B组3例术前ASIA D级患者,术后1个月神经功能均恢复正常.2组均未发生内固定相关并发症.A组1例术后切口愈合不良,换药后愈合.结论 悬臂梁复位法恢复伤椎前缘、后缘高度优于反弓折顶复位法,且术中操作简单易行、术中出血量少.

目的:评估后路减压Dynesys动态内固定治疗腰椎退变性疾病的长期临床疗效.方法:收集2008年7月～2013年12月在我院采用后路减压Dynesys动态内固定治疗的腰椎退变性疾病患者的临床资料,其中163例患者获得78～144个月(95.4±15.6个月)随访,男97例,女66例;年龄31～60岁(43.5±11.7岁).单节段固定117例,双节段固定42例,三节段固定4例.比较患者术前、术后3个月和末次随访时的Oswestry功能障碍指数(Oswestry disability index,ODI)和腰腿痛视觉模拟量表(visual analogue scale,VAS)评分;在术前、术后3个月和末次随访时的腰椎正侧位和前屈后伸位X线片上测量手术节段和上位邻近节段活动度(range of motion,ROM)及椎间高度,评估影像学和症状学邻近节段退变(adjacent segment degeneration,ASD)发生情况以及内固定相关并发症.结果:术后3个月及末次随访时的ODI和VAS评分均较术前显著性改善(P＜0.05),末次随访时与术后3个月时比较差异亦有统计学意义(P＜0.05).术前、术后3个月和末次随访时手术节段的ROM分别为7.8°±2.1°、4.6°±1.4°和3.9°±1.5°,手术节段椎间高度分别为12.1±2.9mm、12.8±3.5mm和10.9±2.8mm,上位邻近节段ROM分别为8.3°±1.9°、9.2°±2.7°和10.2°±2.8°,术后3个月及末次随访时与术前比较、末次随访时和术后3个月比较均有统计学差异(P＜0.05);上位邻近节段椎间高度分别为12.7±3.1 mm、12.6±3.2mm和12.1±2.8mm,差异均无统计学意义(P＞0.05).末次随访时32例(19.6％)患者手术节段ROM小于4°(临床融合组),131例(80.4％)大于4°(非融合组),两组患者术前、术后3个月和末次随访时的VAS评分和ODI均无统计学意义(P＞0.05).末次随访时30例(18.4％)患者出现影像学ASD;2例(1.2％)患者出现症状学ASD,其中1例行翻修手术,另1例行保守治疗.1例患者术后2个月出现术区深部感染,抗感染治疗后痊愈;6例患者在术后5年随访时出现单侧螺钉松动,均未行手术治疗.2例患者出现椎弓根螺钉断裂,无不适症状未给予翻修手术.所有患者均无手术节段症状复发.结论:后路减压Dynesys动态内固定治疗腰椎退变性疾病可获得良好的长期临床疗效,并能保留手术节段部分活动度.

目的 评估术前低蛋白血症与高龄患者腰椎融合术后并发症的相关性.方法 回顾性分析2013年1月至2014年12月,89例因腰椎退行性疾病在我院接受腰椎后路融合术的75岁以上患者临床资料,其中男41例,女48例;年龄75～87岁,平均(78.9±3.0)岁.根据术前血清白蛋白的水平(以35 g/L为界)分为低蛋白组(n=23)和正常组(n=66).比较两组患者术前合并症和术后3个月内并发症的发生情况,采用回归分析评估低蛋白血症与高龄患者腰椎融合术后并发症的相关性.结果 本组平均随访时间(27.9±7.2)个月,低蛋白组和正常组术后总并发症发生率分别为43.5％(10/23)和19.7％(13/66),差异有统计学意义(P=0.02).低蛋白组非手术并发症和泌尿系感染发生率分别为39.1％(9/23)和26.1％(6/23),均高于正常组的18.2％(12/66)和7.6％(5/66)(P=0.04和P=0.02).两组术后住院>14天患者比例分别为43.5％(10/23)和21.2％(14/66)(P=0.04).回归分析结果显示,相对于正常组,低蛋白血症组患者术后总并发症发生风险为3.14[95％CI:1.13～8.73,P=0.03],非手术并发症风险为2.89(95％CI:1.02～8.23,P=0.04),泌尿系感染风险为4.31(95％CI:1.17～15.85,P=0.03),术后住院时间>14天风险为5.78(95％CI:2.07～16.09,P=0.01).结论 低蛋白血症是高龄患者腰椎融合术并发症的独立危险因素,低蛋白血症能够增加术后总并发症、非手术并发症、泌尿系感染以及术后住院时间>14天的风险.

Objective:To investigate the complications and prevention strategies of Dynesys stabilization in the treatment of lumbar degenerative disease.Methods:Two hundred and forty-three patients underwent lumbar spine stabilization with Dynesys owing to lumbar degenerative disease were retrospectively analyzed from July 2008 to December 2016. The mean follow-up time was 5.6 years (48-148 months). There were 152 patients with lumbar disc herniation and 91 patients with lumbar spinal stenosis. 167 cases underwent single-level operation, 71 cases underwent two-level operation, and 5 cases underwent three-level operation. All patients had low back pain, radiating pain in the lower extremities, and/or intermittent claudication. Clinical outcomes were evaluated using Oswestry disability index (ODI) and visual analogue scale (VAS). The occurrence of perioperative complications (with in 3 months) and postoperative complications (after 3 months) after the operation were recorded and analyzed. Radiographic adjacent segment degeneration (ASD) was evaluate dusing University of California at Los Angeles Grading Scale (UCLA).Results:All patients underwent surgery successfully. ODI score of patients improved from 55.1%±16.8% preoperatively to 15.6%±5.8% at the final follow-up, the difference was statistically significant ( t=34.6, P<0.01). VAS score decreased from 6.4±2.3 preoperatively to 1.1±0.4 at the final follow-up, the difference was also statistically significant ( t=35.4, P<0.01). There were 25 cases (10.29%) with complications, and 3 cases (1.23%) underwent secondary operation. Perioperative complications occurred in 13 patients (5.35%), including 5 cases of cerebros pinal fluid leakage, 5 cases of poor wound healing (2.06%), and 3 cases of deep wound infection (1.23%). Twelve patients (4.94%) had long-term postoperative complications, including 6 patients (2.47%) of unilateral screw loosening at the 5-year follow-up, 3 patients (1.23%) of screw fracture, and 3 patients (1.23%) of symptomatic ASD, among whom 2 patients underwent secondary operation, and 1 patient underwent conservative treatment. There was no recurrence at the operated segments in all patients. At the final follow-up, 41 patients (16.87%) had radiographic ASD. The UCLA score atthe final follow-up was significantly different from that preoperatively ( Z=2.60, P=0.01). Conclusion:Dynesys dynamic system combined with decompression in the treatment of degenerative lumbar spine diseases can achieve good long-term clinical outcome, with low incidence of complications and ASD.

目的 评估短节段减压固定术治疗老年退行性脊柱侧凸合并腰椎管狭窄的临床疗效.方法 回顾性分析2014年1月至2017年12月,我院采用后路短节段(<3节段)固定融合手术治疗的59例老年(>65岁)退行性脊柱侧凸合并腰椎管狭窄患者,根据Berjano分型分为Ⅰ型组(40例)和Ⅱ型组(19例).患者年龄65～88岁,平均75.4岁,随访时间18～36个月,平均25.1个月.记录患者手术时间、术中失血量、术后并发症的发生情况,评估两组患者术前、术后随访时腰部和下肢的疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI),比较术前和术后随访时患者侧凸Cobb's角、脊柱矢状位平衡(sagittal vertical axis,SVA)和腰椎前凸角(lumbar lordosis,LL)的变化情况.结果 两组患者年龄、性别、随访时间、术前神经根阻滞患者数、手术时间、术中失血量差异均无统计学意义(P>0.05),组间手术节段差异有统计学意义(χ2=5.09,P=0.02).末次随访时两组患者腰部和下肢VAS以及ODI均较术前明显改善,差异有统计学意义(P<0.05),组间差异无统计学意义(P>0.05).BerjanoⅠ型和Ⅱ型患者侧凸Cobb's角分别由术前的(17.2±3.5)° 和(19.1±4.2)° 降至术后3个月时的(10.3±2.7)° 和(10.5±3.1)°,而末次随访时分别增加至(14.3±2.9)° 和(15.2±3.9)°,与术前相比差异均有统计学意义(FⅠ=51.5,P<0.01;FⅡ=25.5,P<0.01),而SVA和LL术前、术后无显著变化(P>0.05).两组共有20例(33.9％)出现并发症,其中围术期并发症15例,远期并发症5例,两组间差异无统计学意义(P>0.05).结论 短节段减压固定手术治疗BerjanoⅠ型和Ⅱ型老年退行性脊柱侧凸合并腰椎管狭窄,具有满意的短期临床疗效,能够改善侧凸畸形.

恶性肠梗阻 (malignant bowel obstruction, MBO)指原发性或转移性恶性肿瘤造成的肠道梗阻,是晚期肿瘤常见的并发症,通常合并炎性水肿、电解质紊乱、肠道动力异常、肠道菌群失调及药物不良反应等因素,从而使病情进一步复杂及恶化.对于终末期恶性肿瘤合并 MBO 病人,剧烈的持续腹痛是影响其生活质量的最重要因素之一.专家共识 [1] 推荐使用阿片类药物(吗啡、芬太尼等)和抗胆碱药物(氢溴酸东莨菪碱、山莨菪碱等)用于镇痛治疗,在临床实践中有时镇痛效果并不理想.经过查阅资料,发现吗啡阿托品注射液(含盐酸吗啡 10 mg,硫酸阿托品 0.5 mg)用于麻醉和手术前给药可加强麻醉药的效力,并减少病人手术前的恐怖与诱导期不适,遂尝试其在终末期恶性肿瘤合并 MBO 能否达到更为理想的镇痛效果.本研究收集 48 例终末期 MBO 病人,对其镇痛治疗进行分析.

目的 探讨个性化手术对多节段脊髓型颈椎病(CSM)的治疗效果.方法 对122例CSM患者依据压迫部位、退变范围、颈椎矢状位序列、手术史及合并症等综合因素制订个性化手术:颈前路椎间盘切除椎间植骨融合内固定术(ACDF)组32例,ACDF联合颈前路椎体次全切除减压融合术(ACCF)组48例,后路单开门椎管成形微型钛板内固定术(ODLF)组42例.通过疼痛VAS评分、JOA评分及颈椎曲度指数(CCI)进行疗效分析.结果 患者均获得随访,时间10～19个月.ODLF组手术时间较短,失血量较多,与ACDF组和ACDF+ACCF组比较差异有统计学意义(P<0.05);ACDF组和ACDF+ACCF组的手术时间和失血量比较差异无统计学意义(P>0.05).术后VAS、JOA评分:3组均较术前有明显改善(P<0.05),3组间比较差异无统计学意义(P>0.05).术后CCI:ACDF组、ACDF+ACCF组与术前比较差异均有统计学意义(P<0.05),ODLF组与术前比较差异无统计学意义(P>0.05),3组间比较差异无统计学意义(P>0.05).ODLF组并发症发生率高于ACDF组和ACDF+ACCF组,差异有统计学意义(P<0.05).结论 个性化手术治疗多节段CSM能取得较好疗效,手术方式对CSM疗效无影响.前路手术时间略长,失血量少,ODLF并发症发生率较高.

颈腰痛是一种常见病症,多数是因为慢性肌肉损伤、小关节紊乱和椎间盘突出症等,诊疗首先是进行鉴别诊断,排除肿瘤、血管畸形、脊髓病变以及其他内脏疾病,再明确有无手术指征。目前,颈腰痛多数先采用非手术治疗,经过3～6个月后效果不佳或有急性压迫症状,需行手术治疗。非手术治疗

Objective We tried to eatablish pilot lumbar spine 3 d finite element model and to prove the consistency of models with clinic.Methods Through the establishment of pilot lumbar spine 3 d finite element model,high Gz lumbar stress distribution of the environment was simulated,combined with of 48 cases pilot clinical damage of the lumbar spine X-ray analysis.Results pilot lumbar spinal three dimensional finite element model of Lumbar spine was of consistent with the clinical X-ray,stress injury of L1 wedge is high incidence.Conclusion lumbar spinal three dimensional finite element model can simulate the pilot high Gz stress state under the environment of lumbar spine.

Objective To compare the effect of interior heat needle therapy on morphology of chronic gastrocnemius muscle tendon injury and brain-derived neurotrophic factor(BDNF) level in rats.Methods Twenty-seven healthy male Wistar rats were randomly divided into injury control group(n=12),interior heat needle therapy group(n=12) and normal control group(n=3).Rat in normal control group and injury control group did not receive any treatment.A chronic soft tissue injury model was established.Three rats in injury control group and interior heat needle therapy group were killed 3,7,14 and 28d after treatment.Morphology of inured tissue and BDNF level were observed under optical microscope with immunohistological staining.Results The changes of morphology indicated that the tissue repair was better in interior heat needle therapy group than in injury control group.No significant difference was observed in tissue repair between the two groups 3d after treatment(P0.05).However,the tissue repair was much better in interior heat needle therapy group than in injury control group 7 and 14d after treatment(P0.05) and less in interior heat needle therapy group than in injury control group 28d after treatment(P0.05).Conclusion Interior heat needle therapy can significantly increase the basic fibroblast growth factor(BFGF) level and is thus effective for chronic soft tissue injury in rats.

Objective To observe the effects of the internally heated needle and other micro-trauma therapy on VEGF and BFGF in the repaired tissue(gastrocnemius muscle tendon junction and sural nerve)of rats with chronic injuries.Methods seventy-five healthy male Wistar rats were randomly divided into injury control group(n=12),internal heated needle group(n=12),silver needle with heat group(n=12),silver needle without heat group(n=12),small needle knife group(n=12),radio frequency therapy group(n=12)and normal control group(n=3).The level of VEGF and bFGF in the repaired tissue were measured at day3,7,14 and 28.Results The bFGF and VEGF activity in all therapy groups are higher than that in the injury control group on the day3,7 and 14(P0.01).On day 3,the internal heated needle group and the silver needle with heat group showed higher results than others(P0.01);day 7and day 14's levels of VEGF and bFCF were the highest(P0.01);on day 28,the statistics of the therapy groups decreased compared to those of the control group(P0.01),and the statistics of the internal heated needle group and the silver needle with heat group were lower than those of others(P0.01).Conclusions The internal healed needle and the silver needle with heat treatments can increase the bFGF and VEGF activity in rats after their chronic skeletal muscle and nerve injury.The former is relatively better than the latter in therapeutic effect.

For slurry recirculation can improve the performance of anaerobic digestion system while inadaptable recirculation rate may lead to acidification,an anaerobic digestion experiment was carried out on kitchen waste to analyze the effect of slurry recirculation.Results showed that the average daily biogas production was increased by 0.7%,13.0% and 4.9% than its non-recirculation period when the recirculation rate was 10%,30% and 50%,respectively.Slurry recirculation had no harm to the methane percentage.With an increased recirculation rate,system's buffer capacity reduction performed better,but high recirculation rate(50%) would lead to sodium ion accumulation.

OBJECTIVE:To explore the clinical value of intraoperative magnetic resonance imaging (MRI) and functional neuronavigation in the preservation of the language function during microsurgery for lesions near language-related brain regions.METHODS:Sixty-one right-handed patients underwent microsurgical resection of the lesions near the language-related brain regions with the assistance of intraoperative MRI and blood oxygen level- and diffusion tensor imaging-based functional neuronavigation. The patients were divided into 2 groups according to the location of the lesions, namely group A with lesions near the left posterior inferior frontal gyrus and group B with lesions near the left posterior superior temporal gyrus. The aphasia quotient (AQ) of all patients were obtained using Western Aphasia Battery (WAB) before and 2 weeks after the operation.RESULTS:In the 33 patients with a normal AQ score (≥93.8) before the operation, the AQ score underwent no significant changes after the operation (P>0.05). Twenty-eight patients had lowered AQ scores (〈93.8) preoperatively, which were improved significantly after the operation (P<0.01). At 2 weeks after the operation, the language function worsened in 14 patients (23.0%), and only 2 (3.2%) showed a persistent language deficit at 6 months. Of the 61 patients, radical resection of the lesions was achieved in 41 and subtotal resection in 20 patients. The variation of AQ scores after the operation was not found to correlate to the degree of lesion resection, and the patients in group A showed a greater AQ variation than those in group B.CONCLUSIONS:Intraoperative MRI and functional neuronavigation can well demonstrate the structural relations between the lesions, the cortical areas and the fasciculi related to language functions, thus helping to better preserve the language function during microsurgical lesion resection in patients with lesions near language-related brain regions.

OBJECTIVES:To explore the clinical value of functional neuro-navigation and high-field-strength intraoperative magnetic resonance imaging (iMRI) for the resection of intracerebral gliomas involving eloquent language structures.METHODS:From April 2009 to April 2010, 48 patients with intracerebral gliomas involving eloquent language structures, were operated with functional neuro-navigation and iMRI. Blood oxygen level dependent functional MRI (BOLD-fMRI) was used to depict both Broca and Wernicke cortex, while diffusion tensor imaging (DTI) based fiber tracking was used to delineate arcuate fasciculus. The reconstructed language structures were integrated into a navigation system, so that intra-operative microscopic-based functional neuro-navigation could be achieved. iMRI was used to update the images for both language structures and residual tumors. All patients were evaluated for language function pre-operatively and post-operatively upon short-term and long-term follow-up.RESULTS:In all patients, functional neuro-navigation and iMRI were successfully achieved. In 38 cases (79.2%), gross total resection was accomplished, while in the rest 10 cases (20.8%), subtotal resection was achieved. Only 1 case (2.1%) developed long-term (more than 3 months) new language function deficits at post-operative follow-up. No peri-operative mortality was recorded.CONCLUSIONS:With functional neuro-navigation and iMRI, the eloquent structures for language can be precisely located, while the resection size can be accurately evaluated intra-operatively. This technique is safe and helpful for preservation of language function.

Objective To observe the effect of internal heated needle and silver needle on SOD、MDA in repaired tissue after chronic skeletal muscle injury in rats.Methods Sixty healthy male Wistar rats were randomly divided into injury control group(n=18),silver needle group(n=18),internal heated needle group(n=18)and normal control group(n=6).The volume of SOD and MDA in the repaired tissue were detected at 1 d、7 d and 14 d.Results SOD activity in the internal heated needle group(35.31±2.68)and the silver needle group(36.26±3.12)was decreased compared with that in the injury control group(41.35±5.51)at 1d after treatment(P0.05).At 7d and 14 d,compared with the injury control group(48.15±6.44、38.70±5.03),SOD activity in the internal heated needle group(64.87±2.69,56.77±3.02)and the silver needle group(59.09±3.16,51.69±2.91)was obviously increased(P0.01).Furthermore,SOD activity in the former was higher than that in the latter at 7 d and 14 d(P0.05).The value of MDA in the internal heated needle group(6.39±0.34)and the silver needle group(6.28±0.24)was increased compared with that in the injury control group(5.91±0.28)at 1d after treatment(P0.05).At 7 d and 14 d,compared with the injury control group(4.83±0.27,4.10±0.43),the value of MDA in the internal heated needle group(3.96±0.16,3.11±0.19)and the silver needle group(4.23±0.24、3.54±0.21)was obviously decreased(P0.01).Moreover,the value of MDA in the former was lower than that in the latter at 7 d and 14 d(P0.05).Conclusions The internal heated needle and the silver needle can decrease MDA level and increase SOD activity after chronic skeletal muscle injury in rats.The former is relatively better than the latter in therapeutic efficacy.

Objective To evaluate the impact of high-field intraoperative magnetic resonance imaging (iMRI) on extension of resection and surgical strategy modification for glioma surgery. Methods One hundred and six patients, admitted to our hospital from October 2009 to June 2010, were performed glioma resections with the help of high-field iMRI. Questionnaires were filled and collected prospectively to record the surgeons' intention on the extent of resection (EoR) and the intra-operative estimation of EoR before every iMRI scan. The scan imagings were collected based on the request of the surgeon, and the percentage of tumor removal was calculated according to the iMRI data. The impact of iMRI on the tumor EoR and modification of surgical strategy was then evaluated. Results Preoperatively, 48 patients were intended to achieve total tumor removal, 41 sub-total tumor removal, and 17 partial removal. The first intraoperative MRI scan revealed that 42 (39.6%) patients achieved complete resection, while residual tumors were depicted in 64 (60.4%).Further tumor resections were performed in 39 patients (36.8%), but the other 25 patients could not perform further resection for their tumors were closely neighbored to the important functional region or important tracts. Finally, in the whole cohort, the percentage of tumor resection volume was increased from (76.5±20.5)% to (94.2±8.7)%, with significant differences (U=2.000, P=0.000); 67 patients got complete removal, 25 sub-total removal and 14 partial removal; The total removal rate was significantly increased from 45.3% (48/106) to 63.2% (67/106): the average percentage of tumor resection volume in the second time of scan ([93.6±12.41%) was obviously increased as compared with that in the first scan ([86.3±20.21%, U=4.000, P=0.000). Conclusion High-field iMRI may increase the extent of glioma resection, and has significant impact on the intraoperative modification of the surgical strategy.

Objective To evaluate the reliability of high-field intra-operative magnetic resonance imaging(iMRI) in detecting the residual tumors during glioma resection.Method One hundred and thirty-one cases of brain glioma(69 males and 62 females,aged from 7 to 79 years with mean of 39.6 years) hospitalized from Nov.2009 to Aug.2010 were involved in present study.All the patients were evaluated using magnetic resonance imaging(MRI) before the operation.The tumors were resected under conventional navigation microscope,and the high-field iMRI was used for all the patients when the operators considered the tumor was satisfactorily resected,while the residual tumor was difficult to detect under the microscope,but resected after being revealed by high-field iMRI.Histopathological examination was performed.The patients without residual tumors recieved high-field MRI scan at day 4 or 5 after operation to evaluate the accuracy of high-field iMRI during operation.Results High quality intra-operative images were obtained by using high-field iMRI.Twenty-eight cases were excluded because their residual tumors were not resected due to their location too close to functional area.Combined with the results of intra-operative histopathological examination and post-operative MRI at the early recovery stage,the sensitivity of high-field iMRI in residual tumor diagnosis was 98.0%(49/50),the specificity was 94.3%(50/53),and the accuracy was 96.1%(99/103).Conclusion High-quality intra-operative imaging could be acquired by high-field iMRI,which maybe used as a safe and reliable method in detecting the residual tumors during glioma resection.

Objective To explore the effect of high-field intra-operative magnetic resonance imaging(iMRI) combined with language functional neuronavigation in resection of glioma in language area of dominant hemisphere of the brain.Methods Twenty right handed patients(12 males and 8 females,aged from 20 to 61 years with mean of 43.6 years) with glioma close to arcuate fasciculus were involved in present study,and they were stratified into normal group(n=9) and aphasia group(n=11) according to the preoperative aphasia quotient(AQ).All the patients underwent surgical operation assisted by arcuate fasciculus navigator,and the high-field iMRI was performed with a 1.5-T magnetic resonance scanner.The 3D reconstructed arcuate fasciculus images were integrated into neuronavigation system before the operation,and used by combining with functional neuronavigation under microscope during the surgical procedure.Pre-operatirely,and 2-4 weeks,3-6 months postoperative,the patients were examined with magnetic resonance scanning and aphasia quotients examination.Results Pre-operative and intra-operative arcuate fasciculus reconstruction was completed in all the 20 patients,and neuronavigation under microscope were performed after the 3D images integrated into neuronavigation system.Patients of normal AQ(94.5±5.5) retained the normal level,except one patients who developed new conduction aphasia syndrome(AQ=81.8) 2-4 weeks after operation.The AQ of aphasia group(89.4±5.8) was significantly improved than that before operation(84.9±8.7,P < 0.05),except 2 patients whose language deficit was exacerbated due to tumor recurrence.The AQ of normal group(98.3±0.5) remained at normal level,while that of aphasia group(95.2±2.6) was significantly improved 3-6 months after operation compared with that at 2-4 weeks after operation(P < 0.05).There were no other new neurologic deficits and death in both groups.Conclusion High-field iMRI combined with functional neuronavigation is a safe and reliable technique for maximal resection of tumors adjacent to important language areas or conduction tracts,with minimal neural injury,and is beneficial to post-operative recovery.

Objective To observe the effect of different acupuncture therapy on microvascular perfusion after blunt skeletal muscle injury in rats using laser-Doppler perfusion imaging.Methods Thirty male Wistar rats were randomly divided into normal control group,spontaneous recovery group,calor internus acupuncture group,silver acupuncture plus heating group,and silver acupuncture not plus heating group,6 rats in each group.The left gastrocnemius muscle was blunt injured in the last 4 groups.The blunt injuries in the last 3 groups were treated with different acupuncture therapy after 15 days.Changes in microcirculation of the left gastrocnemius muscle were observed and recorded,and compared with those in the other two groups.Results A significant difference was observed in microcirculation between the 5 groups and normal control group(P0.05).No significant difference was found between the calor internus acupuncture group and silver acupuncture plus heating group,while a difference was observed between the silver acupuncture not plus heating group and normal control group(P0.05).Conclusion Acupuncture therapy is effective for microvascular perfusion failure after blunt skeletal muscle injury in rats.

Objective To summarize the surgical experiences of removal of the lesions in and around the lateral ventricle trigone via high occipital approach under neuronavigation.Methods The clinical data of 35 patients with lesions in and around the lateral ventricle trigone were analyzed retrospectively.The lesions were removed via a high occipital approach by guidance of BrainLAB neuronavigation.The incision site was 5 to 8 cm superior to the external occipital protuberance and 2 to 4 cm lateral to the midline.The aphasia quotient(AQ) scores before and after the operation were analyzed statistically.Results Total resection of lesions was achieved in 31 patients and subtotal resection in 4.The postoperative pathological analysis showed that there were 14 cases of meningioma,11 of glioma,4 of cavernous hemangioma,2 of metastasis,1 of ependymoma,1 of central neurocytoma,1 of choroid plexus papillary carcinoma and 1 of germinoma.The hemiparalysis was aggravated in 3 patients and hemianopia occurred in 2 after operation.Thirty-five patients were followed up for 3 to 12 months,and there was obvious improvement in 3 hemiparalysis patients and 1 hemianopia patient,but another hemianopia patient unchanged.Compared with the early stage after operation,the language function of 5 patients with preoperative speech impairment was improved significantly(AQ=95.2±2.58,P<0.05).The function of 30 patients with preoperative normal speech remained unchanged(AQ=94.9±6.37) but 2 patients whose language function was worsened.Conclusions Brain surgery via high occipital approach by guidance of neuronavigation has several advantages such as convenient operation,good surgical field exposure condition and getting out of the important nerve conduction bunches,which could result in decrease of postoperative dysfunction rate,thus is an effective method for treatment of lesions in and around the lateral ventricle trigone.